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Most of the couples I see in my practice complain about having mismatched libidos, when one person wants more sex than the other.

There are also couples, though, who used to have good sex lives but who rarely have sex any more, and would like this to change. It is difficult enough to talk about your sex life, but admitting you don't have one at all is even more embarrassing. These couples also often believe they are the only ones with this problem.

It was easy for them in the early years: they met, fell in love and had sex as often as possible. Then things gradually changed and they are left wondering what happened to the strong desire and passion they once had.

This might coincide with becoming more domestic, working longer hours and, for some couples, starting a family. Women who have young children and demanding workloads at home and work are often too tired to even think about sexual pleasure. This can also be a problem for men as they can be too tired or distracted to want sex.

It is important to remember that these stresses are normal under certain circumstances and that after a period of not much sex, intimacy will resume. But couples should keep engaging in non-sexual intimacy to stay connected.

A sexless relationship is defined as having sex fewer than 10 times a year. In most relationships, sexual satisfaction is a measure of the entire relationship. If a once-satisfying sex life becomes one in which sex is infrequent or non-existent, it's more likely there are other aspects of the relationship that are unsatisfactory.

When I talk to clients who are in a relationship that is lacking sex, my advice is: start fixing the issues before it is too late. Everyone is different, and there are many reasons couples do not want sex.

There are some common reasons: not being satisfied with their sex life, no longer being attracted to their partner, body-image issues, sexual dysfunction, stress, depression or anxiety.

Stress has become part of our lives and has a tendency to create tension between partners. If it stays unresolved, it results in anger and misunderstandings. When couples don't sort out these problems, sooner or later resentment will surface and intimacy and sex will go on the back-burner.

Sometimes, when I ask my clients when they last had sex, they tell me: "I can't remember." Men sometimes acquire sexual dysfunction - it's not easy when a man, for whatever reason, starts having difficulties with his erections or with premature ejaculation. When this happens, he may start having performance anxiety and, instead of addressing the issue, he often starts avoiding sex. If he doesn't discuss this problem with his partner they will grow apart, leaving him or her frustrated, resentful and angry.

For women, there can be different reasons for not wanting sex much any more. There are still many women (about 70 per cent) who don't experience an orgasm during intercourse. I advise them not to complain but to show their partners how to give them an orgasm during foreplay or intercourse, or after, by hand, oral sex or sex toy.

Men are no mind-readers, and communicating openly is the best way to get results. There are also women who have never had an orgasm, and I suggest they should try to learn how to have one, so they know what they are missing out on.

Unlike men, women can have sex with their partners any time they want - they don't need to be very excited, and they can choose to make love for reasons other than strong desire. They may do it because they like feeling close or emotionally connected to their partner, to nurture loving feelings without having mind-blowing orgasms all the time. Sometimes they might do it to make their partner happy, as the alternative is to not have sex at all.

Now, I don't tell my female clients to just do it, but they often tell me: "Sometimes I just don't feel like having sex, but when I actually do it, I start enjoying it and I am happy I instigated it."

We should not forget there are many health benefits of having sex, and that by being intimate partners, the relationship outside the bedroom is also much stronger.

Not all sexless relationships are doomed. It is fine, as long as both people are happy not to have sex any more. Unfortunately, this is rare.